Neurology group advocates caution for athletes after suspected concussions

Dr. Christopher C. Giza (left), of the UC Los Angeles School of Medicine, and Dr. Jeffrey S. Kutcher of University of Michigan Medical School, discuss new concussion guidelines Monday during a press conference at the San Diego Convention Center.
Paul Sisson

Dr. Christopher C. Giza (left), of the UC Los Angeles School of Medicine, and Dr. Jeffrey S. Kutcher of University of Michigan Medical School, discuss new concussion guidelines Monday during a press conference at the San Diego Convention Center.

Coaches should remove athletes from play if they suspect a concussion in order to minimize the risk of further injury, according to new guidelines released Monday by the American Academy of Neurology at its annual conference in San Diego.

The new guidelines move away from a previous rating scale that graded concussion severity and allowed players to return to the field in as little as 15 minutes.

Pushed by the deaths of high-profile players like Junior Seau, sports-related concussions and brain injuries have been hot topics in recent years, leading parents, families and physicians to speak out with ever more regularity on the costs and consequences of big hits.

Several experts said Monday that the academy’s new guidelines are congruent with other policies already in place at most levels of athletics.

Guideline co-author Dr. Christopher Giza, of the division of pediatric neurology at the UCLA School of Medicine, said that athletes should remain on the sidelines unless a licensed medical professional trained in concussions is available to perform a diagnosis.

“The return to play on the day of the sport event would only be done in the minority of cases where there is a trained professional there, and that trained professional has to make a diagnosis of something other than a concussion for the athlete’s condition,” Giza said.

He stressed that concussion symptoms do not always show up quickly after a heavy blow is delivered to a player’s head. For that reason, he said, the guidelines advocate no hard-and-fast timeline for return to play.

“If there’s uncertainty as to whether there is a diagnosis of a concussion, that individual wouldn’t go back,” Giza said.

Dr. Julian E. Bailes, a neurosurgeon with the University of Chicago’s Pritzker School of Medicine, said he was glad to see the academy add its voice to the growing number of organizations pushing for more stringent concussion protection for athletes.

Bailes, who is the medical director for Pop Warner Football and has consulted for the NFL Players Association and for the NCAA, said elimination of the academy’s previous tiered concussion rating system made sense.

“I think they’re trying to make a point that, in every case, it’s an individualized diagnosis. You need to take each one on a case-by-case basis,” Bailes said.

That is apparently already happening for California’s high school athletes. Rebecca Brutlag, media relations officer for the California Interscholastic Foundation, said a recent law and a policy change in 2010 already require an individualized approach.

“If there are signs and symptoms of a concussion, they cannot return to play until a physician has cleared them to play,” Brutlag said, adding that, starting this year, coaches are also required to receive additional training in concussion detection.

Chris Radford, a spokesman for the NCAA, said in an email that college athletes are under the same type of policy.

“NCAA athletes who are suspected to have a concussion are not allowed to return to play that day and must be cleared following evaluation before eventually returning to practice or play,” Radford said.

The National Football League also adopted a similar return to play policy in 2009.

The league, which is facing lawsuits from former players and their families, including the relatives of the late Junior Seau whose May 2012 suicide brought new levels of attention to the issue of brain injury in sports, introduced certified athletic trainers at all games in week 16 of last season.

The academy relied on a team of experts wrote the guidelines after reviewing concussion studies from 1955 through June 2012. According to the guidelines, the most risky sports, in terms of concussion potential for men and boys, are football and rugby followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

Another key take-away, Giza said, is that helmets can only do so much to absorb heavy blows.

“It’s highly likely that there won’t ever be a helmet technology that is concussion-proof,” Giza said.

To assist with concussion diagnosis, the academy has released a “Concussion Quick Check” application that is available for Apple and Android-based mobile devices like smartphones and tablets.